Identify the following image?

NORCET-7 Mains-2024

Obstetrics & Gynaecology

Medium

Appeared in: NORCET-7 Mains-2024

Explanation

The image shows a velamentous insertion of the umbilical cord, a condition where the cord inserts into the fetal membranes instead of the main placental disc.
As clearly visible in the specimen, the umbilical vessels separate from the cord and travel unprotected through the chorioamniotic membranes to reach the placenta.
This anatomical variation leaves the fetal vessels vulnerable to compression and rupture, which can lead to fetal hypoperfusion, acidemia, or exsanguination.
This presentation is distinct from other placental abnormalities like battledore (marginal insertion), succenturiate (accessory lobe), or circumvallate (fibrous ring).

Option A: A circumvallate placenta is characterized by a thickened, opaque, white circular ridge on the fetal surface, composed of a double fold of chorion and amnion. This feature is not present in the image.
Option C: A battledore placenta involves the umbilical cord inserting directly into the margin (edge) of the placental disc. The image shows the cord inserting into the membranes at a distance from the placental edge.
Option D: A succenturiate lobe is an accessory placental lobe that is separate from the main placental disc, connected by fetal vessels running through the membranes. The image shows a single main placental mass.

Visual 1: Diagram - A comparative illustration showing a normal central cord insertion alongside velamentous, marginal (battledore), and succenturiate lobe placentas. This helps clarify the anatomical differences.
Visual 2: Sonogram with Color Doppler - An ultrasound image showing vasa previa, where velamentous vessels are seen crossing the internal cervical os. This highlights the most dangerous complication associated with velamentous insertion.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Identification of placental abnormalities, specifically variations in umbilical cord insertion as background academic context rather than a clinical decision trigger.
Nurses must carefully inspect the placenta and cord after delivery to identify abnormalities like velamentous insertion, which may not have been detected prenatally. This finding should be documented and communicated.
Identification of this condition is crucial as it is associated with higher risks of fetal growth restriction, preterm delivery, low Apgar scores, and stillbirth due to potential vessel compression or rupture.
What if? If these unprotected vessels were found to be crossing the internal cervical os on a prenatal ultrasound (a condition called vasa previa), management would change significantly. Instead of awaiting spontaneous labor, a planned cesarean delivery, typically between 34 to 36 weeks, would be recommended to prevent catastrophic fetal hemorrhage upon membrane rupture or labor onset.

How to Approach the Question

First, carefully examine the provided image of the delivered placenta.
Focus on the key anatomical feature in question: the insertion point of the umbilical cord.
Observe that the cord does not attach to the main body or edge of the placenta. Instead, it attaches to the surrounding fetal membranes.
Note the blood vessels branching from the cord and traveling across the membranes before reaching the placental disc. These vessels lack the protection of Wharton's jelly.
Recall the definitions of the placental abnormalities listed in the options.
Match your visual finding (cord insertion into membranes with exposed vessels) to the correct definition, which is a velamentous insertion.

Concept Tested & Keywords

Concept Tested: Identification of placental abnormalities, specifically variations in umbilical cord insertion.
Stem keywords: placenta, umbilical cord, image identification
Lead-in keywords: Identify

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